title: Insulin-treated type 2 diabetes is associated with a decreased survival in heart failure patients after cardiac resynchronization therapy.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) improves cardiac performance and survival in patients with congestive heart failure. Recent observations suggest that diabetes is associated with a worse outcome in these patients. The aim of the study was to investigate the effect of diabetes and insulin treatment on outcome after CRT.
  
  
  METHODS
  Diabetic status and insulin treatment were assessed in 447 patients who underwent CRT (males 80.8%, mean age 65.7 +/- 9.7 years, ejection fraction 29.9 +/- 6.11%). Patients were stratified in three groups according to the presence or absence of diabetes and insulin treatment.
  
  
  RESULTS
  Nondiabetic patients were 366 (79.6%), noninsulin-treated diabetic patients 62 (13.9%), insulin-treated diabetic patients 29 (6.5%). The estimated death rate was 5.15 per 100 patients-year in the nondiabetic group, 8.63 in noninsulin-treated diabetics (HR 1.59, P = 0.240), and 15.84 in insulin-treated diabetics (HR 3.05, P = 0.004). Cardiac mortality accounted for 81% of deaths in nondiabetic patients and for 56% of deaths in diabetic patients. Diabetic patients tended to have a worse recovery of left ventricular ejection fraction over time (P = 0.057) and of the distance at 6-minute walking test (6MWT) (P = 0.018).
  
  
  CONCLUSIONS
  Insulin-treated diabetes is associated with a worse functional recovery and a higher mortality in patients with advanced heart failure after CRT. While cardiac death accounts for the majority of deaths in nondiabetic patients, a relevant proportion of the mortality in diabetic patients seem to result from noncardiac causes.
authors.affiliation: Department of Cardiology, IRCCS Istituto Clinico Humanitas, Rozzano, Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Mangiavacchi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gasparini
authors.forename: Stefano
authors.initials: S
authors.lastname: Genovese
authors.forename: Daniela
authors.initials: D
authors.lastname: Pini
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Renato
authors.initials: R
authors.lastname: Bragato
authors.forename: Bruno
authors.initials: B
authors.lastname: Andreuzzi
authors.forename: Annamaria
authors.initials: A
authors.lastname: Municinò
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.forename: Paola
authors.initials: P
authors.lastname: Galimberti
authors.forename: Carlo
authors.initials: C
authors.lastname: Ceriotti
authors.forename: Edoardo
authors.initials: E
authors.lastname: Gronda
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use*; D007558:Italy / Q000453:epidemiology; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D013534:Survival; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007328:Insulin